Visualization of Gray Matter Atrophy and Anterior Corticospinal Tract Signal Hyperintensity in Amyotrophic Lateral Sclerosis Using 7T MRI

Two patients with amyotrophic lateral sclerosis (ALS) presenting with different phenotypic descriptions underwent 7T MRI examination: a man with left upper limb amyotrophy due to lower motor neuron–predominant ALS (ALS Functional Rating Scale [ALSFRS] 33/48, left upper limb Medical Research Council [ULMRC] scale 15/25, right ULMRC scale 25/25, upper motor neurons [UMNs] score 17/55), in whom anterior gray matter hemiatrophy could be seen (figure, A); and a woman with spastic tetraparesis due to UMN-predominant ALS (ALSFRS 34/48, left and right ULMRC 21/25, UMNs 55/55) exhibiting lateral corticospinal but also anterior tracts hyperintensities (figure, B), while posterior and lateral sensory tracts were preserved. Consistent with respective clinical features, and in line with recent reports,1,2 these imaging findings open perspectives for white matter/gray matter impairment description in ALS at 7T.

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